Download Interventional Radiology Medical Student Introduction

Interventional Radiology
Medical Student Introduction
Dr Nadeem Shaida
MBBS MRCS FRCR FHEA
Consultant Vascular & Interventional Radiologist
Overview
• What is Interventional Radiology?
– Sub branch of Radiology
– Using imaging to perform invasive procedures
– Fluoroscopy (X-rays), CT, US, MRI main modalities
– “Pinhole surgery”
Overview
• What is Interventional Radiology?
– Sub branch of Radiology
– Using imaging to perform invasive procedures
– Fluoroscopy (X-rays), CT, US, MRI main modalities
– “Pinhole surgery”
• Obvious advantages of minimal access
– Quicker
– Often under LA therefore shorter recovery time
– Able to do procedures in sicker patients
History
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1895 – First Xray Mrs. Roentgen
1st Nobel Prize in Physics
1914-18 “Mobile” Xray Unit
1927 – First angiogram Egas Moniz
1929 – First aortogram Reynaldo dos Santos
History
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1895 – First Xray Mrs. Roentgen
1st Nobel Prize in Physics
1914-18 “Mobile” Xray Unit
1927 – First angiogram Egas Moniz
1929 – First aortogram Reynaldo dos Santos
1953 – Seldinger technique
Key for obtaining access
History
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1895 – First Xray Mrs. Roentgen
1st Nobel Prize in Physics
1914-18 “Mobile” Xray Unit
1927 – First angiogram Egas Moniz
1929 – First aortogram Reynaldo dos Santos
1953 – Seldinger technique
Key for obtaining access
1964 – Charles Dotter – “Father of IR”
First angioplasty
Links with industry forged early
IR = Innovation
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Term“Interventional Radiology” coined in
1967
1966 – Embolisation of spinal AVM
1967 – Judkins coronary catheterisation
1967 – Selective vasoconstriction for GI
bleed
1970s – Development of occlusive “coils”
1973 – Embolisation for trauma
1974 – Thrombolysis for arterial occlusion
1977 – (Chemo)embolisation of liver
tumours
1980 – Cryoablation of tumours
1982 – TIPSS Procedure
1985 – Catheter delivered stent
1990 – Radiofrequency ablation
1991 – EVAR
1999 – Islet cell transplanation
2004 – Selective Internal Radiation Therapy
IR Today?
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Vascular
Non-vascular
Interventional Oncology
Neurointervention
MSK intervention
Many many other procedures!
Vascular IR
• Angioplasty
– Balloon dilatation
– Drug eluting balloon
– Stent
– Drug eluting stent
– Biovascular scaffolds
Vascular IR
• Angioplasty
• Aneurysm repair
– EVAR
– TEVAR
– Visceral aneurysms
– Ruptured AAA
– Branched/Fenestrated EVAR
Vascular IR
• Angioplasty
• Aneurysm repair
• Haemorrhage control
– GI tract
– Pelvic trauma
– Visceral trauma (Spleen/kidney/liver etc)
– Haemoptysis (Bronchial)
Vascular IR
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Angioplasty
Aneurysm repair
Haemorrhage control
Venous interventions
– Ilio-femoral DVT
– PE
– Pelvic congestion syndrome
– Chronic venous occlusive disease
Non Vascular IR
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Drains/Biopsies
Nephrostomy
PTC & Biliary Drainage
Gastrostomy/ feeding procedures
IVC filters
Fibroid embolisation
Varicocoele
TIPSS Procedure
Interventional Oncology
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Transarterial embolisation of liver
Transarterial chemoembolisation
SIRT procedure (Radioembolisation)
Ablative procedures
– RFA
– Microwave
– Cryotherapy
Neurointervention
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Aneurysms – Coiling v Clipping
Carotid stenting
AVM embolisation
Stroke thrombolysis
Venous stenting
IR Weekly Timetable
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Mon am – US list (Biopsy/Ablation assessment)
Mon pm – IR list (Fibroids/Varicocoele)
Tue am – Theatre (EVAR)
Tue pm – Vascular MDT
Wed am – TIPSS (Once/month)
Wed pm – Vascular MRI
Thu am – IR (TAE/SIRT/PVE/Biliary Stenting)
Thu pm – Liver tumour MDT
Fri am – IR (Angioplasty/Stenting/AVM embolisation)
Fri pm - CT
Whos It For?
• Everyone!
Whos It For?
• Everyone!
• But it helps if…
– Hand eye co-ordination
– Adaptability
– Prepared to improvise/innovate
– Interested in emerging technologies
– Teamworking
– Coolness under pressure!
Career Pathway
• FY1/FY2
– Taster week radiology
• Core training (Not essential)
• Radiology training
– Years 1-3 as normal
– Final FRCR sat at beginning of year 4
• Since 2010 – New IR curriculum
– Leads to CCT in Radiology (Interventional Radiology)
– Years 4-6 IR training
Career Prospects
• Good!
– Shortage of radiologists in general
– Shortage of IR highly acute (BSIR 200 deficit)
– Centralisation of services
• In UK national T & Cs
• Other countries well remunerated
• Downsides
– On call
– Specialty creep
Key Resources
• BSIR
– Undergraduate curriculum
– Medical student Links
• CIRSE
[email protected]